The National Antimicrobial Stewardship (AMS) Program, an integral component of the Philippine Action Plan to Combat Antimicrobial Resistance (AMR), gives structure and direction to healthcare facilities to adopt a proactive multidisciplinary approach to promote rational antimicrobial use. One of the six core elements of AMS is the development and implementation of policies, guidelines and linical pathways to improve antimicrobial prescribing and dispensing. Specifically, Core Element 2 states that “all hospitals shall adopt or adapt to their local context the National Antibiotic Guidelines” to optimize antimicrobial use and help improve the quality of patient care and patient safety. Armed with enhanced knowledge provided by the Guidelines, health practitioners at all levels of healthcare are then empowered to appropriately treat common infectious disease syndromes seen among children and adults (e.g. respiratory and urinary tract infections, diarrhea, skin and soft tissue infections, tuberculosis) as well as other diseases for which much irrational antibiotic use prevails in the country.
The challenging task of formulating the Guidelines was given by the Department of Health to the National Antibiotic Guidelines Committee (NAGCOM), a multidisciplinary group of experts in the fields of infectious diseases, epidemiology, pharmacology and public health program management. It was decided from the outset that there would be no need to reinvent the wheel. Divided into subgroups, the NAGCOM reviewed existing evidence-based local and international guidelines and relevant literature, with priority given to guidelines that utilized the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Adaptations of available guidelines and treatment recommendations were made taking into consideration the latest national Antimicrobial Resistance Surveillance Program resistance rates, list of approved drugs in the National Formulary, quality of the evidence, balance of potential benefits and harm, cost-effectiveness, availability of diagnostic tests, feasibility and resource implications. Interim recommendations were discussed en banc and a consensus was usually reached. The interim guidelines were then sent to the specialty/subspecialty societies for their inputs prior to finalizing the Guidelines. Consultations with external technical experts and public health program implementers were also done as needed.
The Guidelines in this handbook contain treatment recommendations for infectious diseases grouped by organ systems and presented in a tabular format for ease of use. Brief descriptions of disease categories with their etiologic agents, corresponding antibiotic regimens (dose, route, frequency and duration) for pediatric and adult patients, relevant comments and key references are presented. A section on surgical prophylaxis, although not treatment-focused, has been added since antibiotic misuse to prevent surgical site infections also needs urgent attention.
How should the Guidelines be used in health facilities? The AMS program stipulates that hospitals should have facility-specific antibiotic guidelines. Depending on local antibiotic susceptibilities, formulary options, costs, and available resources, the AMS Committee of a health facility can adopt or adapt portions of the Guidelines. There are several other ways by which the Guidelines, adopted or adapted, can be used in AMS including: creation of clinical pathways, development of educational modules (print and electronic) for healthcare professionals, implementation of point-of-care interventions (e.g. dose optimization, de-escalation) and prospective audit and feedback, and performance evaluation.
The Guidelines are not intended to supersede a healthcare provider’s sound clinical judgment. Variations in a patient’s clinical presentation (such as presence of comorbidities), patient’s preferences and availability of resources may require judicious adaptation of the Guidelines by individual users.